Trust board slammed for Stafford Hospital’s ‘shocking’ care failings

A focus on cost-cutting led to ‘shocking’ failures in the patient care provided at Mid-Staffordshire NHS Foundation Trust, the public inquiry into the issue has concluded.

Robert Francis’s report, published today, found patients at the trust’s Stafford Hospital were routinely neglected. Examining the care provided between January 2005 and March 2009, Francis said the most basic of needs, such as help with using the bathroom, eating and drinking, were overlooked.

At times, patients were left unwashed for up to a month and visiting family members frequently had to help patients feed themselves or change dressings. Pain relief was often provided late and in the worst cases not given at all and patients were too often discharged before they were ready to go home, leading them to be re-admitted.

‘I heard so many shocking stories of care,’ Francis said. ‘They were people who entered Stafford Hospital and rightly expected to be well cared for and treated. Instead, many suffered horrific experiences that will haunt them and their loved ones for the rest of their lives.’

Budgetary pressures at the trust played their part, the inquiry said. A financial crisis at the end of 2006/07 led to a need to find cuts of £10m. The workforce reduction programme that ensued was not necessarily the only way to achieve the savings, the report said. It also criticised the way the cuts were implemented.

‘It certainly need not have happened without the involvement of staff and the various departments. Instead, a top-down proposal was launched with departments having to identify cuts to fit the predetermined budget.’

This focus on financial savings also led the board to reconfigure wards in an ‘essentially experimental and untested scheme, whilst continuing to ignore the concerns of staff’.

Francis criticised the trust’s board for being ‘disconnected’ from what was happening on the ground at the hospital, relying on apparently favourable external reports from the Healthcare Commission (the then NHS watchdog), but dismissing feedback from staff and patients and the findings of internal assessments. The action it did take was ‘inadequate’ and lacked the necessary sense of urgency.

The inquiry made a total of 18 recommendations for the trust, the wider NHS and the government. These included a review by Monitor of the trust’s foundation status, support for whistle-blowers and a re-evaluation of staff training programmes.

But Francis said the hospital should remain open and acknowledged that its new executive team had made a ‘successful start’ in improving the safety and quality of care.

Responding to the findings, Lyn Hill-Tout, chief executive at Mid-Staffordshire, offered an unreserved apology that the board and individuals working at the trust failed to uphold care standards.

‘The report is rightly damning of Mid-Staffs at that time,’ she said. ‘We have learnt the hard way. We have learnt from that experience and, through listening to the inquiry witnesses, our patients, staff and local community, we try every day to continue to improve the care we provide to our patients.’

She added: ‘There is now independent evidence that the quality of care given to patients at Stafford Hospital has improved considerably over the last few years. These improvements have resulted in reduced mortality rates, low hospital-acquired infection rates and fewer serious complaints.

‘However, we know we still do not get everything right all of the time and are not complacent. As Robert Francis has outlined, many important changes are needed in the NHS, particularly personnel and collective responsibility for ensuring safe, good care to our patients.’

Many NHS organsiations have implemeted cost reduction programmes without such devastating neglect of basic care.

The RCN seems to accept that relatives should provided such care which really leaves a lot to be desired if the professional body doesn't understand the basics of nursing care.The core function of the NHS needs a much more local but independent scrutiny role. Equally minimum standards need adequate resources too.